Are medication-induced salivary changes the culprit of osteonecrosis of the jaw? A systematic review

Abstract

PurposeThis systematic review was performed to assess the potential influence of medication-induced salivary changes on the development of medication-related osteonecrosis of the jaw (MRONJ).MethodsAn electronic search was conducted using PubMed, Web of Science, Cochrane, and Embase databases for articles published up to June 2023. A risk of bias assessment was performed according to the modified Newcastle–Ottawa Scale (NOS). Due to the heterogeneity of the selected studies in relation to the type of medications and outcomes evaluated, a meta-analysis could not be performed.ResultsThe initial search revealed 765 studies. Only 10 articles were found to be eligible based on the inclusion criteria that reported on the impact of salivary changes on MRONJ following the administration of different medications. A total of 272 cases of MRONJ (35% women, 32% men, and 32% with no gender reported) with a mean age of 66 years at the time of diagnosis were included. Patients administered with bisphosphonates, steroids, chemotherapy, thalidomide, interferon, and hormone therapy had a significantly higher association between decreased salivary flow and MRONJ occurrence. In addition, bisphosphonates, denosumab, and other bone-modifying agents showed a significantly higher risk of developing MRONJ owing to the changes in salivary microbiome profiles, cytokine profiles, interleukins, hypotaurine, and binding proteins.ConclusionThe reduction in salivary flow and changes in the concentration of salivary proteins were associated with the development of MRONJ. However, due to the availability of limited evidence, the findings of the review should be interpreted with caution.Prospero review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022327645.

Unveiling Medication-Related Osteonecrosis of the Jaw: A Rapid Review of Etiology, Drug Holidays, and Treatment Strategies

“…Despite these insights, the review does not present specific sensitivity and specificity values for using salivary changes as diagnostic markers for MRONJ [21]. Therefore, while the review highlights a promising avenue for early detection and risk assessment, the actual diagnostic utility of salivary alterations in MRONJ remains to be validated through further research.…”

“…The review illuminates the potential role of salivary alterations as risk factors in the development of MRONJ [21]. It identifies a decrease in salivary flow and changes in salivary protein levels as key indicators that may predispose individuals to MRONJ [21].…”

“…The medication-induced salivary changes are also considered for the assessment of MRONJ risk [21]. The study highlights those various pharmacological agents, including BPs, DS, corticosteroids, and chemotherapy, known to alter salivary composition, secretion levels, and function [21].…”

“…The medication-induced salivary changes are also considered for the assessment of MRONJ risk [21]. The study highlights those various pharmacological agents, including BPs, DS, corticosteroids, and chemotherapy, known to alter salivary composition, secretion levels, and function [21]. The review underscores the protective and functional properties of saliva in maintaining oral homeostasis, including tooth remineralization, buffering of acids, inhibition of harmful microorganisms, prevention of xerostomia, and facilitation of speech and swallowing.…”

“…The review illuminates the potential role of salivary alterations as risk factors in the development of MRONJ [21]. It identifies a decrease in salivary flow and changes in salivary protein levels as key indicators that may predispose individuals to MRONJ [21]. The intricate relationship between salivary changes and MRONJ development is further explored, with particular emphasis on how bone-modifying agents affect the microstructure of saliva [53].…”